Abstract?Overall This proposal is a competitive renewal of the IDeA Program Infrastructure for Clinical and Translational Research (IDeA-CTR)(U54) grant originally awarded in September 2013. The program, titled the Delaware CTR ACCEL Program, has thus currently completed four years of funding at the time of this application. The overall goal of the ACCEL Program remains to provide the key components to allow growth in strategic areas to improve the health of the citizens of Delaware and the nation. Our consortium currently consists of four partners: University of Delaware (UD)?the lead institution; A.I. DuPont Hospital for Children, a part of the Nemours Children?s Health System (Ne- mours); Christiana Care Hospital System (CCHS), the largest health care sys-tem in the state of Delaware; and the Medical University of South Carolina (MUSC), our out-of-state IDeA partner. In this competitive renewal, we will expand our consortium to include Delaware State University (DSU), an American historically black, public univer- sity located in Dover, Delaware. Delaware is an ideal state for a CTR grant as it represents the whole of the USA in a compact form. The population of Delaware (~950,000) mirrors the US population in urban-to-rural citizen ratio and ethnic/racial diversity, with 22% African American, 69% Caucasian, 8% Hispanic, 3% Asian and 1% Native American. The dominance of adult (CCHS) and pediatric (Nemours) hospital systems, which serve at least 85% of the residents of the state, provides a unique opportunity to treat the state of Delaware as a model for examining how healthcare changes can impact population health. Similar to the strong support the ACCEL Program currently enjoys, the part- nering institutions and the State have again agreed to provide over $8.3 M in funds to support ACCEL related activi- ties. The structure and activities of the ACCEL Program have been modified in this competitive renewal. The ACCEL Program now only includes the Administrative Core and the five required key component activities. In addition, based on lessons learned, opportunities discovered, and success achieved, we have made substantive exciting changes to every component of the ACCEL Program. The Overall Specific Aims for the ACCEL Program are to: 1) Provide op- portunities and infrastructure that enhance the ability of outstanding investigators to conduct exciting and impactful clinical and translational research programs in areas of need and opportunity. 2) Recruit, train, and develop clini- cians, scientists, and engineers who will develop innovative, competitive, interdisciplinary, and interinstitutional clin- ical and translational research teams, and 3) Expand and enhance model community engagement outreach research programs that work with the State and other stakeholders to promote health and wellness to a diverse population of Delawareans. The leadership of the ACCEL program is proud of the strong foundation we have created over the past four years and looks forward to continuing to grow clinical and translational research programs that address some of the most important health care needs of Delawareans and all Americans.